I write as an outlet, as two of our children battle cancer, positive for Li-Fraumeni Syndrome. I cannot say how often I have heard the phrase, "I cannot even imagine..." but hope to give a glimpse of what this is like...and to reassure you that it is not all bad, despite the challenges.

Wednesday, November 13, 2013

Civil War

My friend had posted a blog, whose point was that
some people object to the use of war terms in describing cancer, for a
variety of reasons.

I had
tried to respond to this some time ago, but lost the technological war going on
with my Internet on that particular day. In honor of Sherman's march to the Sea, which began 149 years ago this week, I thought that I would post this today.

So, I think that if you were to consider cancer in
warlike terms, I believe that it would be best compared to our own civil war, rather than a
traditional war of invasion. This
was alluded to above in the arguments against using the war metaphor, but I think embracing
these parameters, it really does work. We need to bring under control
elements of our own cellular population that are not functioning according to
the rules. Cancer runs
rebel.

Also, the traditional therapies, or weapons, are not
so discriminating, affecting healthy tissue and cancer cells alike. We all know
that the theory behind chemotherapy lies in the hope that the poison selected
will kill the cancer cells faster than it kills the patient. Thus, cancer is the ultimate war of
attrition, not unlike our own civil war, where the north concluded that it had
a significantly larger population, and thus could outlast the Confederate
south. Horrible, horrific bit of calculus working
there.

I think, either because we have been blessed with a short
memory, or cursed with horrible sense of history in this country, most do not
have a decent understanding of the nature of the conflict that ended nearly 150
years ago. There were more American deaths in that war than all other conflicts
combined. The total number of American casualties during those four years,
civilian military alike,
were mind numbing. When you
consider the number of casualties relative to our much smaller total population
at the time, it was even more appalling.

Cancer, within the human body, carries a similar
burden. Pediatric cancer,
even more so.

Cancer also shares uncertainty with regard to
outcome. There were
absolutely no guarantees that the North would win. We assume the Union victory from our
current perspective, but it was no sure thing. If it were, Lincoln would have
had fewer sleepless nights, hanging out with the telegraph operators, waiting
for news from the battlefield. I
am thinking that if the cancer outcome were certain, I would have slept better
as well, rather than pacing the halls of the pediatric oncology floor, or
crawling out of my own skin waiting for scan results.

There comes a point in a war of attrition, that the
damage to a large portion of the population, or the utter destruction of a
region is deemed necessary for ultimate survival. Doctors weigh the costs and benefits
differently at the beginning of the cancer war, than they do toward the end. I
believe that Lincoln did as well.

What I look to with hope, oddly enough, were the
"advances" in adopting total warfare toward the end of the Civil War,
specifically, Sherman's "march to the sea." This was a 50 mile wide
swath of destruction in the 300 miles between Atlanta and Savannah. Sherman and his army either used or
destroyed every scrap of infrastructure, crops, and private property, leaving
nothing that could conceivably be used by the south to wage war. It was ruthless. Sherman famously said that he would make Georgia "howl," and howl they did. I suspect that there are no elementary schools named for this guy south of the Mason Dixon line.

However, the starving and demoralizing of the south in this
manner in late 1864 was pivotal to the eventual success of the north, and
ending of the war in April of 1865. I think such measures would not have been
considered in 1862, when there remained hope that such collateral damage could be
avoided.

Against cancer, there are drugs already available that
essentially do this same thing, starving tumors, denying them the ability to
thrive, to grow, to spread, the most commonly known among them being
Taxol. If cancer is a war,
this is a good first step to ending it, and to winning.

Today's smart bombs, aimed at particular sites are like
targeted therapies whereby cancer cells are dosed with a poison payload that
does no harm to healthy tissue...even better. They are currently used and more are
being developed. I am
encouraged.

But back in 1864, the Savannah campaign began on
November 15, when William Tecumseh Sherman, having burned Atlanta, boldly (some
say wantonly) abandoned his supply lines, heading for parts unknown even to his
own army, except for a select few. Sherman
had no communication lines either, advising Lincoln that the southern
newspapers would tell of his progress.

For nearly 6 weeks, Sherman put his army of 60,000 on
the line, unable to call for supplies, or more troops to support them. They needed to forage for food in
order to survive, and as such, they needed to continue to move, as they
stripped the land of everything usable, like a swarm of locusts. Sherman called this "hard
war."

Cancer treatment is certainly "hard war,"
and sometimes, like Lincoln, we have to wait for weeks in silence, as we send
forth a new army in boldness, or desperation. We wait to discover what the
consequences are, and the degree of the success of the campaign.

We are forced to wait, as Lincoln did.

Impatiently, anxiously, waiting for news.

Wondering all the while, 'Did it work?'

Waiting...

Finally, on December 25, 1865, "Uncle Billy"
as he was affectionately referred to by his troops, resumed communications and
sent a telegram to Lincoln stating, "I beg to present you as a Christmas
gift the City of Savannah, with one hundred and fifty guns and plenty of
ammunition, also about twenty-five thousand bales of cotton."

It was with great relief that Lincoln learned of this
success, which had remained in great doubt. From this, he was able to bring
about the eventual end to the long and bloody war, with a Union victory.

But, there were huge costs, especially to the areas in
the south. There was an
enormous effort during reconstruction to make our country whole, and the scars,
though faded, remain.

Some hear echoes of Dixie in residual racism all these
years later, which naturally causes concern, and fear. Is it coming back?

About Me

Our pediatric cancer adventure was complicated by the discovery of a genetic mutation (Li-Fraumeni Syndrome) which predisposes two of my children to all forms of cancer. While Brent, now 16, battled osteosarcoma (bone cancer), we found that Lauren, now 13, had a rare brain tumor. Since our initial problems in 2011, Brent developed two subsequent cancers (Metastatic melanoma and AML--a leukemia that required bone marrow transplant) and Lauren had a second brain tumor removed.

I share both the challenges and the blessings of this life, pretty freely.